Preferences for Place of Death if Faced With Advanced Cancer: A Population Survey in England, Flanders, Germany, Italy, the Netherlands, Portugal and Spain

Ann Oncol. 2012 Aug;23(8):2006-15. doi: 10.1093/annonc/mdr602. Epub 2012 Feb 16.

Abstract

Background: Cancer end-of-life care (EoLC) policies assume people want to die at home. We aimed to examine variations in preferences for place of death cross-nationally.

Methods: A telephone survey of a random sample of individuals aged ≥16 in England, Flanders, Germany, Italy, the Netherlands, Portugal and Spain. We determined where people would prefer to die if they had a serious illness such as advanced cancer, facilitating circumstances, personal values and experiences of illness, death and dying.

Results: Of 9344 participants, between 51% (95% CI: 48% to 54%) in Portugal and 84% (95% CI: 82% to 86%) in the Netherlands would prefer to die at home. Cross-national analysis found there to be an influence of circumstances and values but not of experiences of illness, death and dying. Four factors were associated with a preference for home death in more than one country: younger age up to 70+ (Germany, the Netherlands, Portugal, Spain), increased importance of dying in the preferred place (England, Germany, Portugal, Spain), prioritizing keeping a positive attitude (Germany, Spain) and wanting to involve family in decisions if incapable (Flanders, Portugal).

Conclusions: At least two-thirds of people prefer a home death in all but one country studied. The strong association with personal values suggests keeping home care at the heart of cancer EoLC.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adolescent
  • Adult
  • Aged
  • Attitude to Death*
  • Cross-Cultural Comparison
  • Europe / epidemiology
  • Female
  • Humans
  • Interviews as Topic
  • Male
  • Middle Aged
  • Neoplasms / mortality
  • Neoplasms / psychology*
  • Patient Preference
  • Surveys and Questionnaires
  • Terminally Ill / psychology*
  • Young Adult